In April 2022, a patient with a huge soft tissue defect in left lower limb was treated in the Department of Hand Microsurgery, Xuzhou Renci Hospital. The defect was 49 cm×20 cm in size. A huge conjoined abdominal flap was designed with perforating branch of right lateral circumflex femoral artery and inferior epigastric artery as the vascular pedicles. The total length of the conjoined flap was 66 cm with the width of 9-13 cm. An ipsilateral ALTF was taken and it was combined with the conjoined flap in parallel to form an extra-large flap for wound reconstruction. Twenty-two months after surgery, the flap in left leg was not significantly bloated and without ulceration in left heel. The affected leg was not hindering the patient from walking and slow running. Lower Extremity Function Score (LEFS) was used to evaluate the affected leg and a score of 61 was achieved. Only linear scars were left on the donor sites in thighs and abdomen without dysfunction, and scored 4 of Vancouver Scar Scale (VSS).

In April 2022, a patient with a huge soft tissue defect in left lower limb was treated in the Department of Hand Microsurgery, Xuzhou Renci Hospital. The defect was 49 cm×20 cm in size. A huge conjoined abdominal flap was designed with perforating branch of right lateral circumflex femoral artery and inferior epigastric artery as the vascular pedicles. The total length of the conjoined flap was 66 cm with the width of 9-13 cm. An ipsilateral ALTF was taken and it was combined with the conjoined flap in parallel to form an extra-large flap for wound reconstruction. Twenty-two months after surgery, the flap in left leg was not significantly bloated and without ulceration in left heel. The affected leg was not hindering the patient from walking and slow running. Lower Extremity Function Score (LEFS) was used to evaluate the affected leg and a score of 61 was achieved. Only linear scars were left on the donor sites in thighs and abdomen without dysfunction, and scored 4 of Vancouver Scar Scale (VSS).

Objective: To investigate the ameliorative effects of Mushroom on adipose tissue inflammation and glucolipid metabolism in mice fed a high-fat diet, and to provide a theoretical basis for the mechanisms of Mushroom regulating glucolipid metabolism and inflammatory responses. Methods: C57 BL/6 J mice were fed with normal diet(LF) group, high-fat diet(HF)group and high-fat diet + Mushroom(HF+Mushroom) group for 15 weeks.Then, body weight subcutaneous and epididymal white adipose tissue weight were measured. The morphological changes of adipose tissues were compared by HE staining, and the expression of genes related to inflamation, glycolysis and fatty acid oxidation pathways were detected by RT-PCR and Western blot. Results: Compared with the LF group, the HF group had increased body weight, increased subcutaneous and epididymal white fat weight and adipocyte size, and upregulated expression of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), monocyte chemoattractant protein-1(MCP-1), CD68, inducible nitric oxide synthase(iNOS), pyruvate kinase(PK), phosphofructokinase(PFK), hypoxia inducible factor-1α(HIF-1α) and peroxisome proliferator activated receptor alpha(PPARα) in adipose tissues, while the expression of carnitine palmitoyl transferase-1 A(CPT-1 A), cytochrome P450 4 a10(CYP4 a10) and medium-chain acyl-coenzyme a dehydrogenase(MCAD) were downregulated(P<0.05). Compared with the HF group, Mushroom supplementation reduced body weight, adipose tissue weight and adipocyte size, and downregulated the expression of pro-inflammatory factors and glycolytic pathway-related factors in adipose tissues, while the expression of fatty acid oxidation pathway-related factors were upregulated(P<0.05). Conclusion Mushroom can ameliorate inflammation and disorders of glycolipid metabolism in adipose tissues of obese mice.

Disrupted redox status primarily contributes to myocardial ischemia/reperfusion injury (MIRI). NRF2, the endogenous antioxidant regulator, might provide therapeutic benefits. Dihydrotanshinone-I (DT) is an active component in Salvia miltiorrhiza with NRF2 induction potency. This study seeks to validate functional links between NRF2 and cardioprotection of DT and to investigate the molecular mechanism particularly emphasizing on NRF2 cytoplasmic/nuclear translocation. DT potently induced NRF2 nuclear accumulation, ameliorating post-reperfusion injuries via redox alterations. Abrogated cardioprotection in NRF2-deficient mice and cardiomyocytes strongly supports NRF2-dependent cardioprotection of DT. Mechanistically, DT phosphorylated NRF2 at Ser40, rendering its nuclear-import by dissociating from KEAP1 and inhibiting degradation. Importantly, we identified PKC-δ-(Thr505) phosphorylation as primary upstream event triggering NRF2-(Ser40) phosphorylation. Knockdown of PKC-δ dramatically retained NRF2 in cytoplasm, convincing its pivotal role in mediating NRF2 nuclear-import. NRF2 activity was further enhanced by activated PKB/GSK-3β signaling via nuclear-export signal blockage independent of PKC-δ activation. By demonstrating independent modulation of PKC-δ and PKB/GSK-3β/Fyn signaling, we highlight the ability of DT to exploit both nuclear import and export regulation of NRF2 in treating reperfusion injury harboring redox homeostasis alterations. Coactivation of PKC and PKB phenocopied cardioprotection of DT in vitro and in vivo, further supporting the potential applicability of this rationale. Graphical abstract

PURPOSE: The purpose of this study is to investigate the impact of transitional care by a nurse-led multidisciplinary team (MDT) on clinical outcomes and quality of life of patients with ankylosing spondylitis. METHODS: A randomized control study design was used. Subjects were allocated randomly to an experimental group and a control group. The experimental group received intensive transitional care by a nurse-led MDT, whereas the control group received routine nursing care. Disease activity, spinal mobility, comprehensive function, health service utilization, and quality of life were assessed at the baseline and at six months with the Bath Ankylosing Spondylitis Metrology Index, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), a health service utilization questionnaire and version 2 of the Short Form-36 health survey. RESULTS: Compared with the baseline, the BASDAI, BASFI, emergency visits, hospitalizations, hospitalization days, and bodily pain, vitality, mental health, total score, and average score of version 2 of the Short Form-36 health survey were improved in the experimental group (p < .05), whereas only bodily pain, vitality, and role-emotional were improved in the control group p < .05). At six months, the experimental group exhibited significantly more improvement on the BASDAI, BASFI, hospitalizations, all domains except Role-physical as well as total score and average score p < .05) compared with the control group. CONCLUSION: A MDT-based nurse-led transitional care improves clinical outcomes and quality of life of patients with ankylosing spondylitis. Future research should be carried out on modes of follow-up and family support.
Baths ; Emergencies ; Follow-Up Studies ; Health Services ; Health Surveys ; Hospitalization ; Humans ; Mental Health ; Nursing Care ; Patient Care Team ; Quality of Life ; Spondylitis, Ankylosing ; Transitional Care

Objective? To explore the effects of enteral nutrition program based on intensive ultrasound monitoring gastric residual on patients receiving lung transplantation. Methods? Totally 100 patients who received lung transplantation in a Class Ⅲ Grade A hospital between January and December 2016 were selected and divided into the treatment group (n=50) and the control group (n=50) according to the random number table. Patients in the treatment group received enteral nutrition based on intensive ultrasound monitoring gastric residual, while patients in the control group received conventional enteral nutrition. The indicators of enteral nutrition application and complications were observed in both groups. Results? The gastric residual of the treatment group was (130.32±40.44) ml; the nutrition interruption rate was 6%; the time for achieving the target feed volume was (3.47±0.62) d, lower than those of the control group (t/χ2=-2.341, 8.575, 2.193;P＜ 0.05), which were (198.13±40.25) ml, 28% and (5.59±0.71) d. The dripping speed of the treatment group was (87.00±10.59) ml/h, higher than that of the control group (t=6.121, P＜0.05). The incidence rate of aspiration of the treatment group was 4%, and there was no statistically significant difference compared with that of the control group (χ2=0.298; P＞0.05), which was 6%. The incidence rates of enteral nutrition reflux, diarrhea and reintubation rates of the treatment group were 10%, 10% and 8%, respectively, lower than those of the control group (33%,26%,24%) (χ2=6.250, 4.336, 4.762; P＜ 0.05) . Conclusions? The enteral nutrition program based on intensive ultrasound monitoring gastric residual conforms to target-oriented nursing care for patients receiving lung transplantation, which helps to achieve the target feed volume more quickly and ameliorate enteral nutrition-related complications.

Objective? To investigate the effect and safety of high-flow nasal cannula (HFNC) oxygen therapy for patients after extubation in lung transplantation. Methods? A retrospective study was conducted on 60 hospitalized patients with lung transplant during January 2017 to December 2017 in Wuxi People＇s Hospital. According to the different methods of respiratory support prescribed after extubation, the patients were divided into two groups: observation group (n=28, via HFNC) and control group (n=32, via nasal oxygen tube) . The two groups were compared in terms of the clinical indicators including their blood gas analysis(oxygenation index, lactic acid, partial pressure of carbon dioxide) , viscosity of sputum and comfort, etc. Results? Six hours after extubation and before transferring to other departments, the observation group＇s oxygenation index was(263.70±48.97)and(273.22±43.26)mmHg, which were statistically different from those of the control group with (217.83±77.30)and(229.08±68.64)mmHg respectively (P＜ 0.05). Before transferring to other departments, the partial pressure of carbon dioxide in the observation group was (37.04±8.56)mmHg, lower than the control group with (42.43±6.14)mmHg with a statistical difference (P＜0.05); the viscosity of sputum in the obseration group was lower than the control group with statistical difference (P＜0.05); the patients＇ comfort in the observation group achieved (7.72±1.06)points, higher than the control group＇s (4.39±0.82)points with statistical difference (P＜ 0.05). Conclusions? HFNC oxygen therapy for the patients after extubation in lung transplantation has good effects, is safe and reliable, and can be widely applied in clinical practice.

Objective To summarize the experiences of postoperative care of 7 patients with lung transplantation patients receiving high flow nasal cannulae oxygen therapy. Methods The key points to ensure the success of operation were oxygen therapy waiting for lung transplantation,sequential treatment after tracheal intubation, assisted by fiberoptic bronchoscopy, nasal high flow oxygen therapy failed to switch to non-invasive treatment or re intubation. Results All 7 patients got through the intensive care period successful. Conclusions High flow nasal cannulae can improve the comfort and compliance of lung transplant patients,and easy to operate.

Objective To investigate the effects of analgesia and sedation scheme on ICU delirium among patients with cardiac surgery. Methods A total of 235 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January to December,2016, and divided into the experimental group(117 cases)and the control group(118 cases).The experimental group received analgesia and sedation scheme designed by our department,and the control group received routine sedation protocol. The incidence of ICU delirium, the dosages of drugs, duration of mechanical ventilation, length of ICU stay were recorded. Results The compliance rate of shallow sedation in the experimental group was 87.17% (102/117), which was lower than 57.62% (68/118) in the control group with statistical difference(χ2=25.642,P<0.05).The incidence of ICU delirium in the experimental group was 17.09% (20/117), which was lower than 34.75% (41/118) in the control group with statistical difference (χ2=9.524, P<0.05). The dosages of sedation drugs were: dexmedetomidine, (269.46 ± 32.47) μg,disoprofol,(286.84±81.96)mg,the duration of mechanical ventilation was(14.31±1.43)h,the length of ICU stay was(16.02±1.25)h.Those data were all lower than those of the control group[(507.29±58.27) μg,(575.63±95.74)mg,(20.45±2.29)h,(22.82±2.45)h]with statistical difference(t=-5.529--4.371, P<0.05). Conclusion Analgesia and sedation scheme was worthy of popularization and application.

This paper summarized nursing care in intra-hospital transfer of 13 critically ill patients with extracorporeal membrane oxygenation. The key points to guarantee safety of critically ill patients were establishing a well-trained professional team and developing standardized procedures,and applying checklist for ECMO Transfer. The key points in nursing were assessment and pretreatment,homogenized nursing during transfer and effective handover after transfer. As a result,six cases of avian influenza patients successfully completed CT ex-amination,five cases of lung re-transplant patients and two cases of lung transplant patients were successfully trans-ferred to the operating room.